Cited by 260Meta-analysis and systematic reviewsClinical practice guidelines implementationDelphi Technique in Research

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Using systematic reviews in guideline development: The GRADE approach

Zhang, Yuan, Akl, Elie A., Schünemann, Holger J.·2019·Research Synthesis Methods

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Abstract

Systematic reviews are essential to produce trustworthy guidelines. To assess the certainty of a body of evidence included in a systematic review, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Working Group has developed an approach that is currently used by over 100 organizations, including the World Health Organization and the Cochrane Collaboration. GRADE provides operational definitions and instructions to rate the certainty of the evidence for each outcome in a review as high, moderate, low, or very low for the effects of interventions, prognostic estimates, values and preferences, test accuracy, and resource utilization. The assessment includes assessing risk of bias, imprecision, inconsistency, indirectness, and publication bias, the magnitude of effects, dose‐response relations, and the impact of residual confounding and bias. Summary statistical information and assessments of certainty are presented in GRADE evidence summary tables, which can be produced using GRADE's official GRADEpro software tool ( www.gradepro.org /). The evidence summary tables feed into the GRADE Evidence to Decision frameworks which guideline panels can use to produce recommendations.

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Authors: Zhang, Y., Akl, E. A., & Schünemann, H. J.
Affiliations: McMaster University (CA)
Corresponding author: Schünemann, Holger J.
ORCID: Zhang, Yuan
Akl, Elie A.
Schünemann, Holger J.
Venue: Research Synthesis Methods
Publisher: Wiley
Published: 2018-09-25
Volume: 10
Issue: 3
Pages: 312-329
ISSN: 1759-2879 (ISSN-L)
1759-2887
DOI: 10.1002/jrsm.1313
OpenAlex: W2884972765
Cited by: 260
References: 67
Citations by year: 2026: 38 · 2025: 51 · 2024: 44 · 2023: 42 · 2022: 31 · 2021: 29 · 2020: 13 · 2019: 10
FWCI: 2.58
Type: journal article
Language: en
Open access: closed
Licence: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations: Research Synthesis Methods (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Social Sciences › Sociology and Political Science › Delphi Technique in Research
Keywords: GRADE, quality of evidence, systematic reviews, clinical guideline development, risk of bias, imprecision, inconsistency, indirectness, publication bias, dose-response relationship, residual confounding, evidence-to-decision framework

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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Using systematic reviews in guideline development: The GRADE approach

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